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Received September 16, 2020, accepted October 16, 2020, date of publication October 21, 2020

International Survey of Clinical Engineering Professionals
By Y. David1, S. Calil2, N. Pallikarakis3, M. Poluta4, K. Stavrianou5, S. Bergamasco6, D. Clark7, T. Judd8, J. Wear9, T. Easty10    

1 Global Clinical Engineering Summit Chairman, USA
2 Clinical Engineering Professor, Brazil
3 Chairman of the Institute of Biomedical Technology, Greece
4 Clinical Engineer, South Africa
5 IFMBE/Clinical Engineering Division Secretariat, UK
6 Italian Clinical Engineers Association (AIIC), Italy
7 Clinical Engineering, Nottingham University Hospitals NHS Trust, UK
8 IFMBE/Clinical Engineering Division Chairman, USA
9 Clinical Engineering Consultant, USA
10 Clinical Engineering Professor, Canada

ABSTRACT
To determine the maturity of a profession one must have knowledge of the individual attributes of the practitioners of that profession and 
the universal strength of unique skills among them. We have conducted an international survey of Clinical Engineering (CE) professionals 
associated with the management of technological tools developed for and deployed within the healthcare delivery system. The survey tar-
geted participants who are practicing engineering tasks related to the safe and efficient management of technology used in the delivery of 
healthcare services. The participants, consisted of cohort of individuals whose contact information was collected from attendees at previous 
clinical and biomedical engineering events including: (1) presentation at congresses/regional meetings, (2) serving on international techni-
cal committees or task forces, (3) attending virtual clinical engineering events, or (4) subscribing to the Global Clinical Engineering Journal. 
The purpose of the survey was to identify the state of organization of CE professionals and the potential gaps, if any exists, in meeting their 
professional development needs. The survey was developed and conducted using on-line internet apps and links that provided access to a 
questionnaire in six different languages to facilitate optimal participation and response accuracy in as many geographical regions as pos-
sible. The survey was conducted in the early part of 2020 over period of 6 weeks. The overall response rate1 was over 5% (total of 14,400 
individual contacts less estimated 1,750 contacts who did not open/bounced back). A total of 667 responses from 89 countries were received. 
This survey is considered an improvement, over previously reported international surveys,2,3 with regard to response volume and rate. The 
strength of this survey, having larger response volume and geographical representation, when compared with previously documented CE 
surveys has improved even with narrower time window of data collection. The current survey consisted of twelve questions, beginning with 
information request about the respondent professional affiliation and moves on to request the ranking of the criticality of C.E. specific issues, 
while another question provided for comments in free formatting text style. The responses received were in all of the seven languages posted 
and included representation from all the continents. The analysis of the survey responses shows that about 60% of the responders identified 
themselves as clinical engineers, 16% as other type of engineers, 13% as technicians, and 12% as health professionals. Responses to particular 
questions demonstrate highest ratio of number of affirmative to negative responses. They were related to the perceived value responders 
placed on stronger international collaboration and on their willingness to engage in it. A conclusion, based on the analysis of the responses to 
this international survey, that the CE profession is awaiting the consolidation of the momentum generated by growing healthcare needs and 
present global conditions. The identified gap is lack of a dedicated international representation that is clearly identifiable within the CE field.  
Analysis of the survey data suggests the need of an international framework focusing on the various CE professional groups/associations and 
their members to face present challenges. The establishment of a global alliance to clearly identify the field of clinical engineering; to promote 
public awareness; to form liaison with government agencies and other healthcare decision makers, will improve global cooperation and inter 
CE societal relations that will serve  patients as well. 

Keywords – Clinical engineering, survey, questionnaire, global, association, professional, technicians, health, international, 
alliance, collaboration.

Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

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David et all: International Survey of Clinical Engineering Professionals 

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David et all: International Survey of Clinical Engineering Professionals 

The optimal survey format to be used is based on 
literature of systematic survey and analysis of the use of 
international population surveying methods in various 
other fields. Our survey used a questionnaire template 
style following an introductory statement about its pur-
pose and identifying its administrators and timetable 
for response acceptance. Clear and simple questions’ 
language, together with a small number of questions 
and the use of multiple-choice questions style were all 
intended to help increase survey response rate.11 Since 
the total size of the international community of practic-
ing C.E. is unknown at present and the response rate of 
previous survey was low9 the sampling methods for this 
research study was probability sampling12 where mem-
bers of the community are chosen randomly. The survey 
questions were translated into six different languages, in 
addition to English, to facilitate better response rate from 
the different continents and countries. The languages 
used included: English, Spanish, French, Arabic, Chinese, 
French, and Russian. 

A short introductory that preceded the questionnaire 
explained for the community who received it the survey’s 
purpose and the importance of completing the question-
naire. It is presented in figure 1 below.

The questionnaire consisted of twelve questions, eight 
of them (shown in table 1 below) having multiple choice 
answers, three asking for additional information and 
one provides space for free text format at the end of the 
questionnaire to collect un-prescribed comments. The last 
question asks the responders for ranking of professional 
challenges faced by the clinical engineer practitioners. 
The main questions are shown in the following table 1 
below and the full questionnaire in its original form is 
found in the appendix.

TABLE 1. Questionnaire format 

Question Response

Are you a member of one of the 
following professional groups:

Engineer - A Clinical/biomedical 
Engineer

Engineer (other) 

Clinical Engineering Technician 
(BMET) 

Scientist - Healthcare Scientists

Healthcare professional 

Professional (Other)

Do you have a representative clinical 
engineering association/society in 
your country?

Yes

No

I do not know

Are you a member of the Association/
Society and do you participate in 
their meetings or programs?

Yes I am a member, and participate 
in its meetings/activities

Yes I am a member, but do not 
participate in its meetings/activities

Not yet, but plan to do so in the 
future

No

Are there any higher education-based 
programs in the area of clinical 
engineering offered in your country?

Yes

No

I do not know

Would you volunteer a few hours 
a month to help advance clinical 
engineering and its application and 
impact locally and globally?

Yes

No

I am not sure

Do you see value in an international 
organization focusing the needs of 
clinical engineering?

Yes

No

I am not sureFIGURE 1. Introduction explaining the purpose of the Questionnaire. 

INTRODUCTION
The dependency of healthcare systems on technology 

for the delivery of their services is at an all-time high 
and projected to continuously grow.4,5 In addition, costs 
associated with the provisioning of healthcare programs 
are showing an increasing trend to consuming a large 
portion of total national gross product.6 To maximize 
patient care outcomes and to achieve optimal return on 
the investment in healthcare technology, it is important 
to manage the healthcare technology life cycle. This is the 
main area that clinical engineers, and related technolo-
gists and technicians are trained to apply their respec-
tive competencies to cost effectively manage and service 
healthcare technology.

To meet the need to determine how well optimal 
management of healthcare technology is improving the 
ability of care providers to practice their profession, 
fundamental data must be collected relating to how well 
the needs of the professionals who manage and service 
this industry are being met.7 The authors intended to 
gain new knowledge about the needs of CE practitioners. 
Specifically, how to overcome lack of opportunities for 
sustaining sharing of knowledge between international 
clinical engineering practitioners due to limited clinical 
engineering professional associations knowledge sharing 
and exchanging. 

Other researchers attempted, in previous work, to 
determine availability and the extent of CEs responsi-
bilities were deployed by using survey methodology and 
concluded that lack of harmonization and wide variation 
are evident in the management of hospitals biomedical 
technology around the world.8 Reported results of one of 
the early surveys looked at CE effectiveness at hospitals 
in developing countries included 163 responses from 43 
countries mostly from Africa, Latin America and Asia.9 

This survey states “This is the first study to collect 
and analyze data on the complexity and state of hospital 
equipment across the developing world; additionally, it 
is the first to collect significant responses from Africa. 
Prior to this study, only 10 developing countries had been 
profiled in international studies.”  To increase knowl-
edge of a field of practice and to identify attributes of 
practitioners in that field can be accomplished through 
a survey. However, limited response volume and the only 
few published surveys recorded in the international CE 

field highlight the challenge that this work is addressing 
in an attempt to gain understanding of current state of 
the CE profession needs.   

A survey that directly seeks answers from the involved 
community according to industry norms suggests that 
“Wherever possible, researchers should use existing 
data, and not bother people again with questions they 
have already answered in other surveys or can be found 
in registers.”10 The International Handbook of Survey 
Methodology7 identifies a survey as “A study that collects 
planned information from a sample of individuals in 
order to estimate particular population characteristics.” 
It further concludes that “Although sample surveys are 
costly and time-consuming, it may turn out that they are 
in many situations simply the best instrument for collect-
ing high quality, relevant data.” we designed the optimal 
survey format to be used. It is characterized by short 
content without open ended style, and yet providing for 
free text format area at the end of the survey to collect 
additional information not included within the formal 
set of questions.

METHODOLOGY
One specific form of data collection method was an 

online survey consisting of a set of structured questions 
that can be clearly understood by the expected respon-
dents. The online survey delivers advantages of being 
easy to respond to and efficient to analyze, having a low 
margin of errors as respondents select buttons and can 
easily change or correct their choices prior to submis-
sion. Available on-line tools can be used to analyze the 
data in variety of determinants. In addition, the survey 
was offered online with applications that could be easily 
be read and responded to on a working station, tablet, as 
well as other mobile devices. 

Most surveys have a goal of being able to make infer-
ences about points of interest in the target population. In 
general, one is faced with the need to make assumptions 
that the persons in the data collection sample are similar 
on the characteristics of interest to persons not in the 
sample to be able to make inferences about the popula-
tion. As such, the design of a survey is critical to its suc-
cess, and therefore special attention should be given to fit 
the survey design and structure the questions to clearly 
preventing possible errors that responders may commit.



David et all: International Survey of Clinical Engineering Professionals 

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David et all: International Survey of Clinical Engineering Professionals 

The fourth question asked if the respondent is a mem-
ber of such an organization and do you participate in its 
meeting or activities; 48% responded that yes, they are 
members and participate. While 17% wrote that they are 
members but do not participate, while 20% said that they 
are not but planned to join in the future, and 15% replied 
with No, as shown in figure 4 below.

The fifth question asked about higher education-based 
programs being offered in the field of CE in your country? 
Responses were 74% Yes, 17% No, 9% I am not sure. The 
sixth question asked: Would you volunteer a few hours a 
month to help advance clinical engineering and its appli-
cation and impact locally and globally? the answers show 
distribution of 86% Yes, 4% No, and 10% Not sure. The 

two questions that received the highest ratio of positive to 
negative responses were question number 7 and question 
8, shown in table 3 below. Question number 7: Do you see 
value in an international organization focusing the needs 
of clinical engineering? This question registered the high-
est positive responses with 93% Yes, 2% No, and 5% Not 
sure. Question seven is important for the understanding 
of the responders’ level of perceived value and need for 
global organization to unite the CE field. To the question 
eight: “Would you participate in the activities of such an 
organization?”, 84% replied with Yes, 4% with No, and 
12% were not sure.

Next, responders were asked to rank in order of 
importance eight topics, shown in table below. These 
topics were discussed at the Global CE Summits13 that 
show continuous growing attendance over the last five 
years as during the 2019 Third International CE and HTM 

FIGURE 3. Graphical representation of the results of question #1: Are you a member of one of the following professional groups?. 

FIGURE 4. Graphical representation of the results of question 
#4: Are you a member of the Association/Society and do you 
participate in their meetings or programs? 

TABLE 3. Responses to survey questions # 7 & #8 

Question Response

Do you see value in an international 
organization focusing the needs of 
clinical engineering?

Yes 612 93%

No 13 2%

I am not sure 32 5%

Would you participate in the activities 
of such an organization?

Yes 553 84%

No 28 4%

I am not sure 76 12%

TABLE 1. Questionnaire format (continue)

RESULTS
The volume of responses to the survey that were col-

lected over relatively short time  ( six weeks) suggests 
that the survey was clear to understand and that subject 
matter was of interest to responders. As a matter of fact, 
the average time to complete the survey was measured to 
be 11:27 minutes for desktops, over 3 minutes for tablets, 
and over 8 minutes for mobile devices all respectfully for 
users of the English language. It is also interesting that 
although the number of responses from English speak-
ing countries like USA, UK, Ireland, Canada, and Australia 
accounted for 121 participants, the number of survey re-
sponses in the English language was 282; suggesting that 
individuals found the survey questions to be sufficiently 
clear even as a second language.  

 Responses were received from all the continents and 
are shown in figure 2 below. The blue color indicates loca-
tion from where responses were received, and the color 
intensity indicates volume of responses with darker blue 
means larger volume. 

The first question was about the professional standing 
of the respondent. Of the total of 669 responses received: 
59% of the respondents identified themselves as clinical 
or biomedical engineer, 16% identified themselves as 
other type of engineer, 13% identified themselves as 
clinical engineering technician, healthcare scientists were 
checked at 5%, healthcare professional at 4%, and other 
professional were marked 3%. A graphical presentation 

of the results of question number # 1 is shown in Figure 
3 below. 

The second question addressed information about the 
prevalence of CE national societies, where 73% answered 
that they have such an association or society, 20% did 
not, and 7% were not sure. 

Question Response

Would you participate in the activities 
of such an organization?

Yes

No

I am not sure

What are the top challenges we should 
address? (you can add your own at 
the end of the list)

Education-Training

Recognition

Professional Standing-Credentialing

Engagement with leaders

Networking

Career progression

Publication opportunity

other
FIGURE 2. World map showing in levels of color intensity origin 
of the responses received. 

TABLE 2. Questionnaire participation by continent 

Continent Participation

Australia 23

Africa (Rwanda, Nigeria, Ghana, Ethiopia, 
Uganda, Egypt, Kenya, Bhutan, Zambia, 
Somalia, Zimbabwe, South Africa, Senegal, 
Benin, Cameroon, Niger, Tanzania, Botswana) 

76

North America (USA, Canada, Mexico, El 
Salvador, Costa Rica)

101

South America (Brazil, Peru, Colombia, 
Venezuela, Argentina, Ecuador, Bolivia, Chile, 
Cuba, Puerto Rico, Uruguay)

200

Asia (China, India, Lebanon, Bangladesh, 
Bhutan, Bahrain, Japan, Jordan, Nepal, Pakistan, 
Philippines, Qatar, Saudi Arabia, Singapore, 
Turkey, United Arab Emirates, Yemen, Syria)

142

Europe (Italy, France, UK, Ireland, Spain, 
Portugal, Greece, Germany, Latvia, Netherlands, 
Sweden, Bosnia and Herzegovina, Czech 
Republic, Russia)

86



David et all: International Survey of Clinical Engineering Professionals 

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David et all: International Survey of Clinical Engineering Professionals 

collaborations across areas and on issues better resolved 
on an international level. As such, the establishment of a 
global structure clearly identifying unified field of clinical 
engineering that will: promote public awareness; form 
liaison with government agencies and other healthcare 
decision makers; and improve international cooperation 
and inter societies relations and will ultimately support 
better  patients care and wellness everywhere. 

ACKNOWLEDGEMENTS
 The authors would like to thank all of the translators 

who helped convert the questionnaire from English into 
additional total of six languages. German Giles (Spanish), 
Saide Calil (Portuguese), Farid Riad (Arabic), Zheng Kun 
(Chinese), Andrei Issakov (Russian), Nicolas Pallikarakis 
(French).

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Congress, Rome, Italy, having record number of accepted 
abstracts and of international participation.14 The top 
challenges that needed to be addressed were listed. The 
analysis of the survey results shows the following order 
for the challenges as were ranked by responders:

DISCUSSION AND CONCLUSIONS
Most of previously reported surveys conducted in 

the clinical engineering field resulted in relatively small 
response volume and rate. These surveys were discussed 
in the introduction segment of this manuscript. The pres-
ent survey was distributed and available for response 
for shorter time duration than the previous surveys and 
yet the volume of the responses was higher. The results 
of this clinical engineering international survey provide 
representative data that suggest gaps in building sus-
tainable global exchange of knowledge and professional 
networking between groups/associations of clinical 
engineering practitioners. 

The survey essentially composes of two parts. The 
multiple-choice questionnaire (part I) and the ranking of 
challenges and free text (part II). The results from part 
I, deem to suggest that a positive change taking place 
in the CE field reflected by growth in the volume of the 
number of national CE associations around the world as 
reflected by the relatively high confirmation response 
rate to question two “do you have CE association in your 
country?” (73%) and to question four about participation 
in such association (48%). In yet another demonstration, 
for same phenomenon observed by the data, is the high 

positive response to the question about availability of 
higher education-based program in your area (74%).   

However, this stands in contrast to the results ana-
lyzed for part II - the ranking of the top challenges the 
responders are facing. The data clearly reveals that the 
most important challenges responders face are limited 
availability of education and training (446 responses), 
follow by lack of professional recognition (361 responses), 
and by absence of professional credentialing programs 
(337 responses). All other listed challenges recorded 
less than 200 responses each, placing higher significant 
on the top three. 

 The data also sufficiently demonstrate a clear and 
overwhelming positive response for the value seen in hav-
ing international organization that will focus on CE needs 
(612 responses) as well as for responders’ intention to 
participate in such an organization (553 responses). It is 
also revealing to see that only 2% of the responders (13 
responses) do not perceive of such a value. The combina-
tion of the results of (part I ) of this questionnaire with 
the ranking of top challenges the CE field is facing (pat 
II), with also the growing attendance at international CE 
congresses, and the recent increase volume of CE publica-
tions15 – reveals a CE field in the midst of a professional 
evolution in need of leadership to further facilitate its 
important impact on healthcare programs. The survey 
highlighted the state of CE associations, networking, pro-
fessional challenges, and the desire for more international 
cooperation that leads needed professional development 
programs. Programs that support expansion of skills, job 
responsibilities and equal participation in healthcare 
teams. Patient care outcomes stand to improve when 
healthcare technology is optimally managed. Identifying 
the global challenges faced by international community 
of CEs is the first step towards overcoming them and the 
shared goal of better healthcare outcomes can then be 
better guided. Establishment of global collaboration and 
structure to achieve partnerships will help to overcome 
barriers, support professional development, and increase 
recognition, as well as addressing other challenges facing 
the CE profession.

 Based on the analysis of the survey data, one such 
initiative can be to unify the global CE field and provide a 
framework for the various professional groups/associa-
tions and their members with continuous opportunity for 

TABLE 4. Questionnaire results show order ranking of top 
challenges in current CE field 

Challenges in CE field Answers

Education-Training 446

Recognition 361

Professional Standing-Credentialing 337

Engagement with leaders 270

Networking 230

Career progression 299

Publication opportunity 184

other 31

https://doi.org/10.31354/globalce.v2i1.70
https://doi.org/10.31354/globalce.v2i1.70
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David et all: International Survey of Clinical Engineering Professionals 

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David et all: International Survey of Clinical Engineering Professionals 

APPENDIX II
Full questionnaire in English.

links/547458fc0cf245eb436dd8ae/Indicators-for-the-
Representativeness-of-Survey-Response.pdf

13. The Global Clinical Engineering Summit, 3rd ICEHTMC 
Congress, Rome, Italy, 2019. https://ced.ifmbe.org/
blog/ifmbe-ced-cestatus-cesummit2019.html

14. International Clinical Engineering and Health Tech-
nology Management Congress, Rome, Italy, October 
21-22, 2019.   http://www.icehtmc2019.com/paper-
submission.html

15. Making a Difference – Global Health Technology Suc-
cess Stories: Overview of over 400 submissions from 
125 Countries. Global Journal of Clinical Engineering, 
Vol.1, No. 1, 2018. https://www.globalce.org/index.
php/GlobalCE/article/view/43 

APPENDIX I
The following question was selected as an example 

for the use of multilanguage translation (English, Portu-
guese, Arabic, Chinese, French, Russian and Spanish) and 
are shown in their original posting in the figures below.

https://www.researchgate.net/profile/Jelke_Bethlehem/publication/267836796_Indicators_for_the_Representativeness_of_Survey_Response/links/547458fc0cf245eb436dd8ae/Indicators-for-the-Representativeness-of-Survey-Response.pdf
https://www.researchgate.net/profile/Jelke_Bethlehem/publication/267836796_Indicators_for_the_Representativeness_of_Survey_Response/links/547458fc0cf245eb436dd8ae/Indicators-for-the-Representativeness-of-Survey-Response.pdf
https://ced.ifmbe.org/blog/ifmbe-ced-cestatus-cesummit2019.html
https://ced.ifmbe.org/blog/ifmbe-ced-cestatus-cesummit2019.html
http://www.icehtmc2019.com/papersubmission.html
http://www.icehtmc2019.com/papersubmission.html
https://www.globalce.org/index.php/GlobalCE/article/view/43
https://www.globalce.org/index.php/GlobalCE/article/view/43


David et all: International Survey of Clinical Engineering Professionals 

J Global Clinical Engineering Vol.3 Issue 2: 2020  14


